Related Experiment Videos
[Preventive cytolytic treatment following heart transplantation: ATG versus OKT3]
A Laske1, L Leonardi, A Gallino
1Klinik für Herzgefässchirurgie, Departement Chirurgie, Universitätsspital Zürich.
Abstract:
The postoperative prophylactic cytolytic therapy with rabbit-ATG and OKT3 after heart transplantation are compared. The first 20 recipients were treated with ATG (5 days), the next 20 with OKT3 (14 days). The medium histological rejection grade (Texas classification) was significantly higher after 2 weeks in ATG group and after 4 weeks in OKT3 group. The linearised rejection rate was 7.1 (ATG) vs. 0.7 (OKT3) (p less than 0.005) at 2 weeks, resp. 3.6 vs. 8.6 (p less than 0.05) and 1.3 vs. 2.9 (p less than 0.005) at 4 weeks and 2 months. After 3 months there was no difference in histological rejection grade (3.6 +/- 1.5 vs. 3.3 +/- 1.7) and linearised rejection rate (2.4 vs. 2.6 per 100 days and patient) between the two groups. Severe rejections are more frequent after OKT3 (6 vs. 11) and probability of rejection free survival is higher after ATG (25% vs. 0%, resp. 21% vs. 0% after 2 resp. 3 months; p less than 0.05). In this study we find no short and medium term benefit of a rejection prophylaxis with OKT3 (14 days) compared with ATG (5 days). Acute allograft rejections in OKT3 group tend to be more severe with a higher mortality.
Insights
Comparing rabbit-antithymocyte globulin (ATG) and OKT3 for heart transplant rejection prophylaxis, this study found no short-term benefit for OKT3. Rabbit-ATG demonstrated a higher probability of rejection-free survival in the initial months post-transplant.
Area of Science:
- Immunology
- Cardiology
- Transplantation Medicine
Background:
- Postoperative rejection remains a significant challenge in heart transplantation.
- Cytolytic therapies like rabbit-antithymocyte globulin (ATG) and OKT3 are used for prophylactic immunosuppression.
Purpose of the Study:
- To compare the efficacy and safety of rabbit-ATG versus OKT3 for prophylactic cytolytic therapy after heart transplantation.
Main Methods:
- A comparative study involving 40 heart transplant recipients.
- Group 1 (n=20) received rabbit-ATG for 5 days; Group 2 (n=20) received OKT3 for 14 days.
- Histological rejection grades (Texas classification) and rejection rates were assessed at 2 weeks, 4 weeks, 2 months, and 3 months.
Main Results:
- Higher histological rejection grades were observed at 2 weeks (ATG group) and 4 weeks (OKT3 group).
- The linearised rejection rate was significantly higher in the ATG group at 2 weeks but higher in the OKT3 group at 4 weeks and 2 months.
- After 3 months, no significant difference in rejection grade or rate was found. Severe rejections and mortality were more frequent in the OKT3 group.
Conclusions:
- Rabbit-ATG (5 days) showed no short or medium-term disadvantage compared to OKT3 (14 days) for heart transplant rejection prophylaxis.
- OKT3 therapy was associated with more severe acute allograft rejections and higher mortality.
- Rabbit-ATG demonstrated a higher probability of rejection-free survival in the early post-transplant period.